L-Shaped Arthroscopic Posterior Capsular Release in Frozen Shoulder
Background: The inadequate arthroscopic release of the tight posterior capsule in frozen shoulder may result in limited postoperative shoulder internal rotation. Indication: The purpose of this article is to describe an L-shaped arthroscopic posterior capsular release to overcome the limited interna...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2021-03-01
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| Series: | Video Journal of Sports Medicine |
| Online Access: | https://doi.org/10.1177/26350254211000065 |
| _version_ | 1819084971964366848 |
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| author | Mohamed Gamal Morsy MD Ahmed Hassan Waly MD Mostafa Ashraf Galal MD El Hussein Mohamed Ayman MD Hisham Mohamed Gawish MD |
| author_facet | Mohamed Gamal Morsy MD Ahmed Hassan Waly MD Mostafa Ashraf Galal MD El Hussein Mohamed Ayman MD Hisham Mohamed Gawish MD |
| author_sort | Mohamed Gamal Morsy MD |
| collection | DOAJ |
| description | Background: The inadequate arthroscopic release of the tight posterior capsule in frozen shoulder may result in limited postoperative shoulder internal rotation. Indication: The purpose of this article is to describe an L-shaped arthroscopic posterior capsular release to overcome the limited internal rotation that may be encountered following the standard longitudinal technique. Operative intervention is indicated in patients with refractory shoulder stiffness with limitation of internal rotation of grade 0, +2, +4 (according to the Constant-Murley Score), after failure of conservative measures for 3 to 6 months. The technique is contraindicated if less than 3 months of physical therapy, shoulder stiffness due to osseous deformity, infection, or cuff tear arthropathy. Technique: After performing a standard anterior capsular release, the scope is shifted to the anterior portal to perform posterior capsular release by introducing the radiofrequency ablation device through the posterior portal. Posterior release begins from the glenoid level down to the 6 o’clock position until the back fibers of the infraspinatus muscle appear. Then the hook-tip part of the radiofrequency ablation device is used to perform a transverse release in the posterior capsule, starting from the beginning of the longitudinal limb. The transverse limb is performed in a stepwise manner going step-by-step laterally but ending before reaching the rotator cuff to avoid any damage of the cuff. After that, the shoulder was manipulated according to Codman technique. Results: A comparative study was performed on 43 patients with primary frozen shoulder to compare the standard longitudinal (22 patients) and L-shaped (21 patients) posterior capsular release. At the final follow-up, there was a statistically significant improvement in the internal rotation range of motion in the L-shaped group ( P < .001). There was no loss of function over time. Moreover, there were no infections, instability, or axillary nerve injury in either group. Discussion/Conclusion: Restriction of internal rotation in frozen shoulder has been attributed to posterior capsular tightness. The L-shaped arthroscopic posterior capsular release in patients with primary frozen shoulder significantly improves the postoperative internal rotation range of motion. |
| first_indexed | 2024-12-21T20:56:57Z |
| format | Article |
| id | doaj.art-409c04b2c6464cf1ad83387fd1ae16e4 |
| institution | Directory Open Access Journal |
| issn | 2635-0254 |
| language | English |
| last_indexed | 2024-12-21T20:56:57Z |
| publishDate | 2021-03-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Video Journal of Sports Medicine |
| spelling | doaj.art-409c04b2c6464cf1ad83387fd1ae16e42022-12-21T18:50:33ZengSAGE PublishingVideo Journal of Sports Medicine2635-02542021-03-01110.1177/26350254211000065L-Shaped Arthroscopic Posterior Capsular Release in Frozen ShoulderMohamed Gamal Morsy MD0Ahmed Hassan Waly MD1Mostafa Ashraf Galal MD2El Hussein Mohamed Ayman MD3Hisham Mohamed Gawish MD4Department of Orthopaedic Surgery and Traumatology, Arthroscopy and Sports Injury Unit, Alexandria University, Alexandria, EgyptDepartment of Orthopaedic Surgery and Traumatology, Arthroscopy and Sports Injury Unit, Alexandria University, Alexandria, EgyptDepartment of Orthopaedic Surgery and Traumatology, Arthroscopy and Sports Injury Unit, Alexandria University, Alexandria, EgyptDepartment of Orthopaedic Surgery and Traumatology, Arthroscopy and Sports Injury Unit, Alexandria University, Alexandria, EgyptDepartment of Orthopaedic Surgery and Traumatology, Kafr El Sheikh University, Kafr el-Sheikh, EgyptBackground: The inadequate arthroscopic release of the tight posterior capsule in frozen shoulder may result in limited postoperative shoulder internal rotation. Indication: The purpose of this article is to describe an L-shaped arthroscopic posterior capsular release to overcome the limited internal rotation that may be encountered following the standard longitudinal technique. Operative intervention is indicated in patients with refractory shoulder stiffness with limitation of internal rotation of grade 0, +2, +4 (according to the Constant-Murley Score), after failure of conservative measures for 3 to 6 months. The technique is contraindicated if less than 3 months of physical therapy, shoulder stiffness due to osseous deformity, infection, or cuff tear arthropathy. Technique: After performing a standard anterior capsular release, the scope is shifted to the anterior portal to perform posterior capsular release by introducing the radiofrequency ablation device through the posterior portal. Posterior release begins from the glenoid level down to the 6 o’clock position until the back fibers of the infraspinatus muscle appear. Then the hook-tip part of the radiofrequency ablation device is used to perform a transverse release in the posterior capsule, starting from the beginning of the longitudinal limb. The transverse limb is performed in a stepwise manner going step-by-step laterally but ending before reaching the rotator cuff to avoid any damage of the cuff. After that, the shoulder was manipulated according to Codman technique. Results: A comparative study was performed on 43 patients with primary frozen shoulder to compare the standard longitudinal (22 patients) and L-shaped (21 patients) posterior capsular release. At the final follow-up, there was a statistically significant improvement in the internal rotation range of motion in the L-shaped group ( P < .001). There was no loss of function over time. Moreover, there were no infections, instability, or axillary nerve injury in either group. Discussion/Conclusion: Restriction of internal rotation in frozen shoulder has been attributed to posterior capsular tightness. The L-shaped arthroscopic posterior capsular release in patients with primary frozen shoulder significantly improves the postoperative internal rotation range of motion.https://doi.org/10.1177/26350254211000065 |
| spellingShingle | Mohamed Gamal Morsy MD Ahmed Hassan Waly MD Mostafa Ashraf Galal MD El Hussein Mohamed Ayman MD Hisham Mohamed Gawish MD L-Shaped Arthroscopic Posterior Capsular Release in Frozen Shoulder Video Journal of Sports Medicine |
| title | L-Shaped Arthroscopic Posterior Capsular Release in Frozen Shoulder |
| title_full | L-Shaped Arthroscopic Posterior Capsular Release in Frozen Shoulder |
| title_fullStr | L-Shaped Arthroscopic Posterior Capsular Release in Frozen Shoulder |
| title_full_unstemmed | L-Shaped Arthroscopic Posterior Capsular Release in Frozen Shoulder |
| title_short | L-Shaped Arthroscopic Posterior Capsular Release in Frozen Shoulder |
| title_sort | l shaped arthroscopic posterior capsular release in frozen shoulder |
| url | https://doi.org/10.1177/26350254211000065 |
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